This application is in response to FOA ?Intervening with cancer caregivers to improve patient health outcomes and optimize heath care utilization? (PAR-16-317) in which we specifically address employed caregivers (CG) and their spousal or partnered cancer patient. Sixty-six million Americans cared for a disabled or ill person in 2015 while CGs of cancer patients represented about 17% of all CGs. Cancer CGs are more distressed than CGs of other medical disorders. Minimal availability of supportive interventions for CGs who care for those with cancer during treatment and afterwards represents an important service disparity. Furthermore, employed cancer CGs must manage multiple responsibilities (the so-called ?sandwich generation?) while still caring for their loved-one. Continued employment of the CG may be required for CGs to provide a source of income and/or health insurance for the family. Interventions specifically addressing stress management for cancer CGs have not incorporated unique needs of employed CGs, tracked CG's healthcare utilization as well as emotional and physiological wellbeing. We will test the influence(s) of an evidence-based psychosocial stress management intervention enhanced for employed CGs preselected for greater distress compared to treatment as usual (TAU) on their depression (the CG primary outcome), CG healthcare utilization, and biomarkers of chronic stress. We will allow CGs to select as desired to reduce CG burden from three effective modalities (one-on-one, video chat, or web-based) similar in content as their stress management intervention. This approach allows greater flexibility for the CG to participate in the intervention and thus improve adherence. We will test the extent to which the CG's participation in the intervention compared to TAU also influences the patient's symptom management, distress, and patient healthcare utilization. Emotional distress will be measured using reliable self-reports of psychological depression, anxiety, and stress for both the CG and the patient. Healthcare utilization will use both self-report alongside an available electronic system, COMPASS. COMPASS includes pharmacy use, laboratory results, physician encounters, hospitalizations, and other information also in the electronic medical record. This study will fill an important gap in our understanding of an intervention enhanced for working CGs on improved health outcomes both for themselves as well as for their patient compared to TAU.